The Circle Expands: Understanding Medi-Cal Coverage of Mild-to-Moderate Mental Health Conditions
August 26, 2016
This issue brief provides an overview of California’s public mental health system in light of the changes brought by the Affordable Care Act (ACA) and other reforms, with particular focus on the implementation of expanded outpatient mental health benefits to treat mild-to-moderate mental health conditions.
Until 2014, Medi-Cal beneficiaries with mental health conditions that did not meet the criteria for specialty mental health services (provided by county mental health plans) only had access to limited outpatient mental health services, delivered by primary care providers or a limited network of fee-for-service mental health providers. As of 2014, Medi-Cal managed care plans are responsible for delivering an expanded set of mental health services, including individual and group psychotherapy, psychological testing, psychiatric consultation, and medication management. These services are available to all Medi-Cal beneficiaries, and limitations on the number of visits and the types of providers have been lifted.
Medi-Cal managed care plans are required to contract with network providers to deliver these mental health services, and while some contract directly with providers, most have subcontracted with a managed behavioral health care organization to support their new mental health coverage responsibilities. The paper describes these contracting relationships and managed care plans’ responsibilities, and includes a list of all Medi-Cal managed care plans and the managed behavioral health care organizations they work with.
The full issue brief is available under Related Materials.